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As Ebola scare continues, let's have some compassion for people who fear illness

People joke about hypochondria, but it’s not a laughing matter, says psychiatrist Dr. Robert Maunder.

Tourists are screened for Ebola this week at an airport in Bangkok, Thailand. Fears of coming down with a dangerous disease should be treated with compassion and respect, a psychiatrist says. (Sakchai Lalit / AP)

Be open with your family and friends about your health fears so you can get the help you need, says Dr. Robert Maunder.

By Dr. Robert MaunderUniversity of Toronto

Tues., Oct. 28, 2014

Walking through the lobby of my hospital after hearing that a nurse in Spain had tested positive for Ebola, and then a man in Texas, and then a nurse who cared for him, I had the sense that each of us was getting in touch with our inner hypochondriac.

Fears about getting sick are almost universal. The more horrific and unfamiliar the illness, the more fear can get under our skin. Never mind that that there are so many boring and familiar risks that are much more likely to get to us — such as traffic accidents or heart disease or plain old influenza.

But maybe a dose of Ebola worry can help us find a little more compassion for people who live with health anxiety every day — the exaggerated fear of having a bad disease that we used to call “hypochondria.”

People make jokes about hypochondria, and as a psychiatrist, I find that troubling. Fearing disease is not so unusual; many people with out-of-control health worries actually have had serious medical issues in the past. Now they’re waiting for the other shoe to drop.

Even if they haven’t experienced such problems, I think health anxiety may be so powerful because we fear few things as much as our own vulnerability. Fear of death, and the inability to protect yourself, are deep-seated.

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People with headaches worry about brain tumours. Muscle weakness can cause multiple sclerosis stress. Dizziness is common and usually harmless, but it’s such an out-of-control feeling that it’s hard to believe there isn’t something seriously wrong.

And then there’s cancer, which wins that contest by far. Everybody knows people who have it and have stories about how a tumour was missed at first. The idea of a foreign thing growing inside you just feels scarier than heart disease, no matter that the actual risk is less.

I think if we open up about our health anxieties, to our families and doctors, people who are truly suffering could get help. And there’s effective treatment, strategies that work much better than just telling yourself to calm down — or worse, being told that by someone else.

So how can you tell when you need to seek help for your health fears rather than your health?

It may be hard to recognize this problem on your own, so be open to what friends, family, co-workers and doctors tell you. When good news comes back from a test, do you think something must have been missed? Does your Internet favourites list tend toward diseases that nobody said you have? If you spend more of time googling conditions you fear, than ones you actually have, that’s also a sign.

In truth, what we used to call “hypochondria” is pretty rare. Less than 1 per cent of people are struggling with a fixed belief they have a serious disease that just isn’t true. These patients need treatment, and Cognitive Behavioural Therapy has proven effective in managing their condition, while medication may help to turn down the volume on their anxiety. Long-term, mindfulness-based meditation also really helps.

Much more common is a kind of “amplified concern” over health. These patients are often information hounds, driven by anxiety to keep reading, much like people glued to their TV screens for the latest on Ebola. People with this sort of health anxiety always seem to find the websites obsessed with the exceptions to the rule. If they are told there’s a 99 per cent chance they don’t have some terrible disease, these sites will help them fixate on that 1 per cent. Not helpful.

I coach these patients to develop ways to manage their fears: being prepared for that anxiety-producing visit to the doctor by arriving on time, bringing a buddy, and writing down questions in advance. They need to reason with themselves when the worry starts up. If Dr. Google is making it worse, I encourage them to stay away — even from reputable sites.

People with health anxiety would also do well to talk to their family doctor about it.

Look at it this way: your doctor probably already knows you’re anxious about your health. By putting your fears on the table, you can talk about the real issue — like your fear of cancer — instead of simply being told (again) that you don’t have cancer.

Speaking openly about your anxiety also allows you to talk about new problems without them being written off prematurely. It allows you to say, ‘I know I’m anxious but what I have right now, this shortness of breath, feels different than when I wake up in the middle of the night with anxiety.’ ”

People with health anxiety need friends and family who can listen to their fears — so long as we set aside the jokes and judgments.

Dr. Robert G. Maunder is a professor in the Faculty of Medicine’s Department of Psychiatry and head of research in Mount Sinai Hospital’s Department of Psychiatry. Doctors’ Notes is a weekly column by members of the University of Toronto’s Faculty of Medicine. If you have a question or comment for one of our experts, email doctorsnotes@thestar.ca

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